UNANG YAKAP

The Essential Newborn Care protocol is a simple, concise and straight ward guideline that is based on solid research evidence. It emphasizes a core sequence of four actions that are performed step by step. It can be enforced immediately in all health care settings.

On December 7, 2009, the Department of Health launched the Unang YakapCampaign. With this campaign, the DOH aims to cut down infant mortality in the Philippines by at least half. The campaign employs Essential Newborn Care (ENC) Protocol as a strategy to improve the health of the newborn through interventions before conception, during pregnancy, at and soon after birth, and in the postnatal period. The ENC Protocol provides an evidence-based, low cost, low technology package of interventions that will save thousands of lives. Based on health statistics, the Philippines is one of the 42 countries that account for 90% of under-five mortality worldwide. 82,000 Filipino children under five years old die every year. 37% of them are newborn. Majority of them (3/4) die within the first two days of life, mostly due to stressful events or conditions during labor, delivery and immediate postpartum period. The current practice of handling newborns, like clamping and cutting the umbilical cord and washing the baby right after birth, have been known to actually contribute to the high incidence of neonatal deaths and illnesses in the country. Thus the need for a paradigm shifts from the prevailing standard procedures into the new protocol. Health Secretary Duque explained that the ENC Protocol involves focusing on the first hours of life of the newborn with the manual guiding health workers in providing evidence-based essential newborn care. The guidelines categorize procedures into:

Time bound procedures should be routinely performed first - immediate drying, skin-to-skin contact followed by clamping of the cord after one to three minutes, non-separation of the newborn from the mother and breastfeeding initiation.

Non time-bound intervention should only be done after the first full breastfeed. These are immunizations, eye care, Vitamin K administration and weighing. Washing must be postponed by at least 6 hours.

The so-called unnecessary procedures include routine suctioning, routine separation of newborns for observations, administration of prelacteals like glucose, water formula and foot printing.

Here's a screen capture of the ENC time-bound intervention flowchart as presented by Dr. Maria Asuncion Silvestre F.A.A.P.

1. IMMEDIATE AND THOROUGH DRYING OF THE NEWBORN immediate and

thorough drying for 30 seconds to 1 minute warms the newborn and stimulates breathing.

2. EARLY SKIN TO SKIN CONTACT BETWEEN MOTHER AND NEWBORN

early skin to skin contact between mother and newborn delay washing for at least 6 hours prevents hypothermia, infection and hypoglycemia.
3. PROPERLY TIMED CORD CLAMPING AND CUTTING properly timed cord

clamping and cutting prevents anemia and protect against brain hemorrhage in premature new born. Properly timed cord clamping means waiting for the cord pulsation to stop (between 1 to 3 minutes)
4. NON SEPARATION OF NEW BORN AND MOTHER FOR EARLY

BREASTFEEDING Continuous non separation of new born and mother for early breastfeeding protects infant from dying from infection, the first feed provides colostrums, a substance equivalent to the babys first immunization in its protective properties. Post-natal care required within 24 hours after birth also includes:

Cord care Breastfeeding Vitamin K injection Eye prophylaxis Delayed bathing until 6 hours of life BCG and first dose of Hepatitis